The Core Distinction in Caregiving Bed Making
In caregiving, bed making is more than just straightening sheets; it is a clinical practice focused on sanitation and patient well-being. The most fundamental distinction is whether the bed is occupied or unoccupied during the process. While some may identify open, closed, or surgical beds, these are variations of the two primary types: making a bed with the person in it versus making it when the person is out of it. A firm, wrinkle-free foundation is key to preventing pressure sores and ensuring maximum comfort for individuals who spend significant time in bed.
Type 1: Making an Unoccupied Bed
An unoccupied bed is one made while the patient is out of bed, such as when they are in the bathroom, using a wheelchair, or are new to the care setting. This is the simplest method and allows the caregiver ample space to work efficiently and create a smooth, tight finish. There are two common variations of an unoccupied bed:
The Open Bed
An open bed is welcoming and ready for use. It is made for a patient who is expected to return shortly, with the top linens and bedspread fan-folded down to the foot of the bed. This makes it easy for the person to get back in without needing to readjust heavy blankets. To prepare an open bed, the caregiver:
- Gathers all necessary clean linen and places it on a clean surface nearby.
- Removes all soiled linens, handling them carefully away from the uniform and placing them in a designated hamper.
- Spreads the clean bottom sheet tightly over the mattress, securing the corners. A fitted sheet is ideal, but a flat sheet can be secured with mitered corners for a tight fit.
- Lays the top sheet and blanket over the bed, making a toe pleat at the foot to provide extra room and prevent pressure on the patient's feet.
- Fan-folds the top linens back for easy patient entry.
- Replaces and fluffs pillows with clean cases, placing the open end of the case away from the entrance.
The Closed Bed
A closed bed is an unoccupied bed that is fully made up with the top linens pulled all the way to the head of the bed, covered with a bedspread. This is typically done to keep the bed clean and tidy when it is not in use, such as for a newly admitted patient or a bed used for naps during the day. When a patient is ready to get into a closed bed, it is converted to an open bed by simply fan-folding the top linens down.
Type 2: Making an Occupied Bed
An occupied bed is made while the patient remains in the bed, and this technique is used for individuals who are unable to get out of bed, such as those recovering from surgery, those on bed rest, or those with significant mobility issues. The occupied method requires careful planning and coordination to ensure the patient's safety, comfort, and privacy are maintained throughout the process. Two caregivers are often recommended for this procedure, particularly with larger or less mobile individuals. The process involves:
- Preparation and Communication: Explain the procedure to the patient and gather all fresh linens. Ensure the bed is flat and at a comfortable working height for the caregiver to prevent back strain. Lock the bed wheels for stability.
- Rolling the Patient: Assist the patient in rolling onto their side, facing away from the side you will begin working on. Use a bed rail for assistance if possible, or another person to help stabilize them. Adjust the pillow to support their head and neck.
- Removing Soiled Linens: Loosen the soiled linens on the working side, rolling them tightly toward the patient's back. Tucking the soiled linen against the patient's back helps keep it separate from the clean area.
- Placing Clean Linens: Lay the clean bottom sheet on the exposed side of the mattress, tucking the edge under. Fan-fold the remaining clean sheet toward the patient's back, next to the soiled linens.
- Shifting the Patient: Assist the patient in rolling over the clean linen onto the other side of the bed. Move to the opposite side, remove the soiled linens completely, and pull the clean sheet across the mattress, making sure it is taut and wrinkle-free.
- Finishing the Top: Assist the patient in rolling onto their back. Place the clean top sheet and blanket over them. Remove the old top linens from underneath, ensuring the patient remains covered for warmth and privacy. Create a toe pleat and miter the foot corners.
Comparison of Occupied vs. Unoccupied Bed Making
| Feature | Unoccupied Bed Making | Occupied Bed Making |
|---|---|---|
| Patient Presence | Patient is out of the bed | Patient remains in the bed |
| Purpose | Readies a bed for a new or returning patient; keeps bed clean | Changes linens for a patient who cannot get out of bed |
| Primary Goal | Efficiency and neatness | Patient safety, comfort, and minimal disturbance |
| Caregiver Effort | Less physically demanding; single person often sufficient | Requires careful coordination; often requires two people |
| Safety Measures | Proper lifting techniques for mattresses | Rolling patient, bed rail use, clear communication |
| Technique Focus | Securing sheets with mitered corners | Minimizing patient movement and exposure |
Enhancing Caregiving Bed Making Skills
Beyond the basic techniques, mastering a few additional skills can greatly benefit both the caregiver and the patient:
- Mitered Corners: This technique creates a secure, hospital-style corner that keeps sheets from coming loose. It involves tucking the sheet neatly under the mattress at a 45-degree angle.
- Toe Pleat: A toe pleat is a simple fold in the top linens that creates extra space for the patient's feet, reducing pressure and preventing foot drop.
- Draw Sheets and Incontinence Pads: These smaller sheets or pads are placed across the middle of the bed to help with patient repositioning and absorb moisture, protecting the main linens.
- Using Assistive Devices: When making an occupied bed, using a friction-reducing sheet or asking for assistance can significantly reduce the risk of injury for both parties.
Conclusion: The Importance of a Well-Made Bed
Understanding and correctly performing the two primary types of bed making in caregiving—occupied and unoccupied—is a cornerstone of providing high-quality, dignified care. An unoccupied bed allows for an efficient and thorough cleaning, while an occupied bed technique ensures a patient's hygiene and comfort are maintained with minimal stress. By mastering these methods, caregivers can create a safe, clean, and comfortable environment for their loved ones, which is vital for their overall health and peace of mind. For more detailed instructions on specific techniques, a guide from the Aplmed Academy is an excellent resource: Bedmaking Procedures Explained.
